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Donor Funding for Health in Low- & Middle-Income Countries, 2002-2013

Detailed Findings

Total ODA

  • ODA rose considerably in the past decade, with disbursements more than tripling between 2002 and 2013, from nominal US$54.8 billion to US$167.0 billion, a 204.7% increase (Table 1). Increases were relatively stable, except in 2005 and 2006, when scheduled, and significant, debt relief transactions were made thereby increasing ODA in those two years (Figure 2 and Annex 1).
  • Some of the increase was offset by inflation and exchange rate changes while a considerable portion was for debt relief and aid to Iraq, Afghanistan, and Pakistan.1,2,3 Aid to Iraq, Afghanistan, and Pakistan, for example, accounted for about 2.1% of ODA disbursements between 2002 and 2013. Debt Relief accounted for approximately 12.3% of ODA disbursements during the same period. After adjusting for these combined factors, the increase over the period in real terms was $84.1 billion, an increase of 126.8%.
Table 1: Total ODA by Major Sector, 2002, 2012, 2013
Gross US$ Disbursements in Billions
2002 2012 2013 2012-2013 2002-2013
+/- $ (%) +/- $ (%)
Health*
4.4
20.1 22.8 +2.7 (13.5%) +18.4 (416.3%)
Water 1.4 6.4 6.4 -0.1 (-1.4%) +5.0 (350.5%)
Education 3.3 11.7 11.7 +0.0 (0.2%) +8.4 (254.5%)
Government/Civil Society 4.8 18.1 18.1 +0.8 (4.6%) +13.3 (279.7%)
Economic Infrastructure 5.6 28.5 28.5 +1.3 (5.0%) +22.9 (407.7%)
Production 3.9 12.8 12.8 +1.4 (12.5%) +8.9 (226.9%)
Commodity Aid 4.9 10.8 10.8 +4.0 (58.0%) +5.9 (119.1%)
Debt Relief 6.5 7.0 7.0 +0.2 (2.3%) +0.5 (7.7%)
Emergency Assistance 3.0 11.2 13.8 +2.5(22.5%) +10.8 (365.1%)
Multisector/Other** 7.0 30.2 32.6 +2.4 (7.9%) +25.6 (367.8%)
Unspecified 10.0 2.3 2.5 0.2 (7.9%) -7.5 (-75.0%)
TOTAL $54.8 $151.5 $167.0 $15.5 (10.2%) +$112.2 (204.7%)
* Represents combined data from three OECD CRS subsectors (1) Health; (2) Population Policies/Programs and Reproductive Health (which includes HIV/AIDS & STDs); and (3) Other Social Infrastructure and Services – Social Mitigation of HIV/AIDS.
** Represents combined data from five OECD CRS sectors and sub-sectors: (1) Multisector/Cross-cutting; (2) Administrative Costs of Donors; (3) Support of NGO’s; (4) Refugees in Donor Countries; (5) Other Social Infrastructure & Services (excluding Social Mitigation of HIV/AIDS).

Health ODA

  • Funding for health increased more than five-fold over the period, rising from $4.4 billion to $22.8 billion, an increase even after adjusting for inflation and currency revaluation (Figure 1 and Annex 1) and grew at a much faster pace (416.3%) than overall ODA (204.7%). Health also grew as a share of overall ODA, rising from 8.1% in 2002 to 13.7% in 2013 (Figure 3).
  • The Health sector demonstrated the third largest increase ($18.4 billion) in ODA over the decade, behind projects that supported Multisectoral or other general efforts ($25.6 billion)4 and Economic Infrastructure ($22.9 billion). Health also accounted for the second largest share of the increase in the 2012-2013 period (17.6% or $2.7 billion), behind Commodity Aid (25.7% or $3.7 billion).
  • While health funding increased each year over the period, the largest increases occurred in the early part of the decade reflecting the start-up of new global health initiatives such as the Global Fund and PEPFAR; between 2003 and 2008, for example, Health grew by $11.0 billion (248.8%), compared to $7.4 billion (48.0%) in the 2008 to 2013 period. After five years of declining year-to-year increases, donor funding for Health increased by $2.7 billion in 2013, representing the largest increase over the study period, and demonstrated the largest year-to-year percent change (13.5%) since 2008 (Figure 4).

Health ODA by Sub-Sector

  • Looking at specific activities within the health sector, the greatest share of funding in 2013 went to HIV/AIDS (35.3%) (Table 2 and Figure 5).5 Basic Health & Infrastructure accounted for the next largest share (19.2%) followed by Family Planning & Reproductive Health (12.6%),6 Malaria (8.6%), and Health Management & Workforce (8.0%). For the first time since 2003, funding for every sector increased from the previous year (Figure 6). Donor funding for Basic Health & Infrastructure experienced the largest increase between 2012 and 2013 ($905.4 million, 26.0%) followed by Nutrition ($371.7 million, 65.5%), Other Infectious Diseases ($369.7 million, 38.1%), TB ($312.4 million, 40.4%), and HIV/AIDS ($289.8, 3.7%).
  • HIV/AIDS drove most of the growth in Health ODA over the 2002 to 2013 period accounting for $7.2 billion (39.2%) of the $18.4 billion increase in health ODA (Figure 7). Basic Health & Infrastructure accounted for the second largest share ($3.4 billion, 18.6%) of the increase, followed by Family Planning & Reproductive Health ($2.0 billion, 10.9%),6 Malaria ($1.9 billion, 10.6%), and TB ($1.1 billion, 5.8%) (Annex 1).
Table 2: Total Health ODA by Sub-Sector, 2002, 2012, 2013
Gross US$ Disbursements in Billions
2002 2012 2013 2012-2013 2002-2013
+/- $ (%) +/- $ (%)
Basic Health & Infrastructure 1.0 3.5 4.4 +0.91 (26.0%) +3.43 (357.5%)
Health Management & Workforce 1.0 1.8 1.8 +0.06 (3.5%) +0.78 (75.2%)
Research 0.0 0.3 0.3 +17 (5.1%) +0.83 (779.9%)
Nutrition 0.1 0.6 0.9 +0.37 (65.5%) +0.83 (779.9%)
Other Infectious Diseases 0.6 1.0 1.3 +0.37 (38.1%) +0.79 (142.2%)
Malaria 0.0 1.8 2.0 +0.20 (11.3%) +1.95 (NA)
Tuberculosis 0.0 0.8 1.1 +0.31 (40.4%) +1.07 (NA)
Family Planning & Reproductive Health6 0.9 2.7 2.9 +0.19 (6.9%) +2.01 (235.1%)
HIV/AIDS 0.8 7.8 8.1 +0.29 (3.7%) +7.22 (855.8%)
TOTAL $4.4 $20.1 $22.8 +$2.71 (13.5%) +$18.39 (416.3%)
Box 2: ODA for Water
While the DAC does not include funding for the Water Sector as part of its definition of “Health,” in prior Kaiser reports, funding for Water was included in overall Health ODA totals, due its relevance to health.  In this year’s report, Water is kept as a separate sector, as defined by the DAC (see Appendix 4), and data specific to funding for Water are provided in tables and charts throughout the report (Table 1, Figure 8, and Annex 3).

  • Water ODA more than quadrupled from $1.4 billion in 2002 to $6.4 billion in 2013; an increase of 350.5% across the period.
  • In 2013, as with the health sector, Sub-Saharan Africa accounted for the largest share (36.8%) of Water ODA.  Far East Asia accounted for the second largest share (16.8%) followed by South & Central Asia (16.5%).
  • The constellation of donors who fund water projects is different from the health sector.  In 2013, Japan was the largest donor to water ODA ($1.3 billion), accounting for nearly one-fifth of water funding (19.9%). The second largest donor was the World Bank ($0.9 billion, 13.9%), followed by Germany ($0.7 billion, 10.1%), the European Commission ($0.6 billion, 8.8%), and the U.S. ($0.4 billion, 6.9%).

Health ODA by Donor

  • Fifty donors provided Health ODA in 2013 (32 bilateral donors and 18 multilateral donors) an increase from 26 donors (21 bilateral and 5 multilateral) in 2002. This increase reflects the creation of new multilateral donors such as The Global Fund and GAVI as well as the entry of new Non-DAC bilateral donors such as Estonia, Kuwait, and the United Arab Emirates (Box 3).
  • While the number of donors has increased over time, the majority of the increase between 2002 and 2013 is largely attributable to the original 26 donors (63%), of which the U.S. accounted for nearly half of the increase. Two new donor entrants accounted for nearly one third of the increase: the Global Fund (22%), which first disbursed funding in 2003, and GAVI (8%), which first disbursed funding in 2007.
  • Most health ODA over the decade was provided bilaterally by donor governments, who collectively accounted for nearly two thirds of disbursements (64.5%) in 2013, with multilateral organizations providing the rest (35.5%) (See Annex 1).7 Bilateral donors provided the greatest share of disbursements in 2013, however, bilateral and multilateral donors accounted for an equal share of the increase in health ODA. While bilateral donors increased their health ODA by 10%, multilateral donors increased health disbursements at a faster rate, providing 20% more than the previous year.8,7
  • The U.S. government was the single largest donor to health over the entire period, including in 2013 ($7.6 billion), when it accounted for over a third of all health ODA (33.5%) (Figure 8). This is up somewhat from 31.7% in 2002; by comparison, the U.S. share of total ODA declined over the period (from 23.5% in 2002 to 16.4% in 2013). The Global Fund, which was created in 2002, has been the second largest donor to Health since 2006 and in 2013 ($4.0 billion) accounted for nearly half of total multilateral funding ($8.1 billion).
  • After the United States, the United Kingdom was the second largest bilateral donor in 2013 ($2.0 billion) followed by the Canada ($0.8 billion), European Commission ($0.6 billion), and Germany ($0.5 billion). After the Global Fund, GAVI was the second largest multilateral donor ($1.4 billion) in 2013 followed by the World Bank ($1.1 billion), and the World Health Organization (WHO) ($0.5 billion).
  • There have been some notable shifts in the donor mix, in part due to the entrance of new donors, particularly the Global Fund and to a lesser extent, GAVI, which are now among the top five donors to global health (Figure 9).
  • Health ODA by RegionThe U.S. allocated the largest share of its total ODA to health (28.0%) among donor governments followed by Canada (21.8%), Ireland (19.4%), the United Kingdom (18.6%), and Luxembourg (16.7%) (Figure 10). When looking at health ODA as a share of gross domestic product (GDP) (standardized by GDP per US$1 million, to account for differences in the sizes of government economies), the U.K. provided the highest amount of resources for health, followed by Luxembourg, the United Arab Emirates, Norway, and Ireland (Figure 11).
Box 3: Measuring Health ODA and Looking Beyond the DAC
The DAC, established in 1961 and with a current membership of 29, is considered to be the world’s main donor group and the primary source for data on development assistance. The DAC collects two sets of development assistance data: one that is high-level data on funding from donor governments (both bilateral and multilateral). This data is referred to as the DAC dataset. Another dataset provides project-level funding data from both donor governments and multilateral organizations (this data is referred to as the CRS dataset). Many non-DAC donor governments (e.g. Turkey, Hungary, etc.) and private donors (e.g. The Bill and Melinda Gates Foundation) provide only high-level data on their development assistance, and not project-level data.

While all donors play a role in funding and defining the global health agenda, emerging, non-DAC donors are increasingly seen as critical to helping fill the global health financing gap. For instance, The Bill & Melinda Gates Foundation disbursed $2.8 billion for global health activities in 2013, which is included in the high-level DAC dataset, but is not available in the project level CRS dataset. Since this analysis utilizes only the project level data (CRS database) it is likely a low-bound estimate of total donor assistance for health.

Health ODA by Region

  • Sub-Saharan Africa received the largest share of health funding of any region in each year between 2002 and 2013 (46.6%) (Figure 12), and accounted for a majority of the growth over the period (57.5%). Funding for the region grew as a share of health ODA between 2002 and 2013, rising from 31.9% to 52.% (Table 3 and Annex 1).
  • Funding for South/Central Asia accounted for the second largest share in 2013 (13.5%). While the region was the second largest driver of growth (11.3%) over the 2002-2013 period, its share of health ODA has declined since 2002 (22.8%).
  • The next largest region, by share of funding in 2013, was Far East Asia (5.6%). All other regions individually accounted for less than 3.0% of total health funding, and funding for three regions (Far East Asia, Europe, and Oceania) declined between 2012 and 2013. Donors allocated a significant portion of health funding (17.8%) without specifying a region.
Table 3: Total Health ODA by Region, 2002, 2012, 2013
Gross US$ Disbursements in Billions
2002 2012 2013 2012-2013 2002-2013
+/- $ (%) +/- $ (%)
North Africa 0.1 0.1 0.2 +0.06 (60.1%) +0.08 (109.3%)
Sub-Saharan Africa 1.4 10.4 12.0 +1.56 (15.0%) +10.58 (751.6%)
North/Central America 0.2 0.6 0.6 +0.03 (5.3%) +0.44 (265.3%)
South America 0.1 0.2 0.3 +0.11 (49.4%) +0.21 (206.9%)
Far East Asia 0.3 1.3 1.3 -0.02 (-1.8%) +0.98 (322.5%)
South/Central Asia 1.0 2.5 3.1 +0.56 (22.1%) +2.07 (205.7%)
Middle East 0.1 0.4 0.4 +0.04 (10.7%) +0.36 (433.0%)
Europe 0.1 0.3 0.2 -0.02 (-8.9%) +0.17 (250.6%)
Oceania 0.1 0.3 0.3 -0.02 (-5.1%) +0.22 (280.1%)
Regional 0.1 0.4 0.3 -0.01 (-2.8%) +0.27 (350.6%)
Unspecified 1.0 3.6 4.1 +0.43 (11.9%) +3.00 (286.4%)
TOTAL $4.4 $20.1 $22.8 +$2.71 (13.5%) +$18.39 (416.3%)
Box 4: ODA for Least Developed Countries
There are a number of ways to categorize recipient countries including by region, income-level, development status, etc. With the development of the new Sustainable Development Goals (SDGs), increased attention has been placed on the 48 Least Developed Countries (LDCs), which account for 12% of the world’s population, but just 2% of the world’s GDP.[1] LDCs are designated by the United Nations (UN) as countries that have “severe structural impediments to sustainable development.” The UN uses three criteria for designating LDCs: gross national income (GNI) per capita, the human asset index (HAI), and the economic vulnerability index (EVI).[1]

  • Total ODA (excluding debt relief) for LDCs has increased from $11.7 billion in 2002 to $48.3 billion in 2013. In addition, 2013 marked the largest increase ($4.6 billion or 10%) in total ODA for LDCs since 2008.
  • Health ODA for LDCs increased each year over the period, rising from 1.2 billion in 2002 to $9.4 billion in $2013. In 2013, Health ODA provided to LDCs increased by $1.5 billion (or 19.2%).
  • While the share of total ODA directed to LDCs has remained essentially flat (approximately 30% over the last seven years), donors have provided an increasing share of Health ODA to LDCs, rising from 27.0% in 2002 to 41.2% in 2013 (Figure 13).
Introduction Conclusion

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